Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Woerthersee, Austria.
Br J Psychiatry. 2024 Oct;225(4):446-453. doi: 10.1192/bjp.2024.112.
Childhood trauma is a major risk factor for chronic depression. It has been suggested that adults with chronic depression who have experienced childhood trauma may require long-term treatment owing to a breakdown of basic trust and related difficulties in developing a productive therapeutic relationship.
As empirical studies have been preliminary and scarce, we studied the effects of psychoanalytic therapy (PAT) versus cognitive-behavioural therapy (CBT) for chronic depression in adults with a history of childhood trauma. In this subgroup, we expected a greater symptom reduction in PAT compared with CBT.
In a large trial of long-term psychotherapies for chronic depression (LAC-Study; Clinical Trial Register ISRCTN91956346), 210 adults received open-ended CBT or PAT in an out-patient setting and were examined yearly over 5 years on the Beck Depression Inventory - II (BDI-II). Based on a linear mixed model approach, we tested participant-reported childhood trauma based on the Childhood Trauma Questionnaire (CTQ) as a predictor and moderator of treatment outcome. CTQ subscales were examined exploratively.
Depressive symptoms decreased over time ( = -4.55, s.e. = 0.90, 95% CI -6.32 to -2.81, = -5.08; < 0.001). A significant three-way interaction between childhood trauma, time and therapy group ( = -0.05, s.e. = 0.02, 95% CI -0.09 to -0.01, = -2.42; = 0.016) indicated that participants with childhood trauma profited especially well from PATs.
Our results indicate differential benefits from PAT compared with CBT among adults with chronic depression and a history of childhood trauma. The results have important implications for differential indication and policy.
儿童时期创伤是慢性抑郁症的一个主要风险因素。有人认为，有儿童期创伤史的慢性抑郁症成年人可能需要长期治疗，因为他们的基本信任已经破裂，并且在发展富有成效的治疗关系方面存在相关困难。
由于实证研究尚处于初步和稀缺阶段，我们研究了儿童期创伤史的成年慢性抑郁症患者接受精神分析疗法（PAT）与认知行为疗法（CBT）的效果。在这个亚组中，我们预计 PAT 比 CBT 会有更大的症状缓解。
在一项针对慢性抑郁症的长期心理治疗的大型试验（LAC-Study；临床试验注册处 ISRCTN91956346）中，210 名成年人在门诊环境中接受了开放式 CBT 或 PAT，并在 5 年内每年接受贝克抑郁量表-第二版（BDI-II）检查。基于线性混合模型方法，我们以童年创伤问卷（CTQ）为依据，检验了参与者报告的儿童时期创伤，作为治疗结果的预测因子和调节因子。CTQ 子量表进行了探索性检验。
抑郁症状随时间的推移而减轻（ = -4.55，s.e. = 0.90，95%CI -6.32 至 -2.81， = -5.08； < 0.001）。童年创伤、时间和治疗组之间存在显著的三向交互作用（ = -0.05，s.e. = 0.02，95%CI -0.09 至 -0.01， = -2.42； = 0.016），表明有儿童期创伤史的参与者尤其受益于 PAT。
我们的研究结果表明，与 CBT 相比，PAT 对有儿童期创伤史的慢性抑郁症成年人有不同的益处。这些结果对差异化指示和政策具有重要意义。
